title: Discrepancy between optic disc and nerve fiber layer assessment and optical coherence tomography in detecting glaucomatous progression.
abstract: OBJECTIVE
  To compare the outcomes of Cirrus spectral-domain optical coherence tomography (OCT) and optic disc/retinal nerve fiber layer (RNFL) photographic assessment in detecting glaucomatous progression.
  
  
  METHODS
  Two-hundred twenty-six eyes of 130 glaucoma patients (mean follow-up: 2.5 years) with at least 5 OCT examinations were included. Eyes were classified into one of four groups (diffuse RNFL defect; localized RNFL defect; no RNFL defect; unidentifiable RNFL status) based on baseline RNFL photographs. After performing the entire series of optic disc/RNFL photographic assessments, the eyes were classified into one of three groups: stable, progressed, and undetermined. Progression was divided into one of four categories (optic disc rim thinning; widening RNFL defect; deepening RNFL defect; new disc hemorrhage). OCT progression was determined using guided progression analysis (GPA) software.
  
  
  RESULTS
  One-hundred thirty-nine eyes had diffuse RNFL defects, 34 eyes had localized RNFL defects, 42 eyes had no RNFL defects, and 11 eyes had unidentifiable RNFL at baseline. Forty-six eyes showed at least one category of progression upon expert assessment of optic disc/RNFL photographs, while OCT GPA detected progression in 35 eyes. Among the 34 eyes in which progression was observed in photographs only, 15 showed a new disc hemorrhage, 12 presented deepening of an RNFL defect, 10 showed optic disc rim change, and 6 had widening of an RNFL defect. Among the 23 eyes processed only by OCT GPA, 18 had a diffuse RNFL defect at baseline.
  
  
  CONCLUSIONS
  OCT GPA was more sensitive in eyes with a diffuse RNFL defect whereas photographic assessment was better for detecting optic disc hemorrhage and deepening of an RNFL defect when evaluating structural progression.
authors.affiliation: Department of Ophthalmology, College of Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnap-2-dong, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Jong Rak
authors.initials: JR
authors.lastname: Lee
authors.forename: Kyung Rim
authors.initials: KR
authors.lastname: Sung
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Na
authors.forename: Kilhwan
authors.initials: K
authors.lastname: Shon
authors.forename: Kyoung Sub
authors.initials: KS
authors.lastname: Lee
mesh_terms: D018450:Disease Progression; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D015203:Reproducibility of Results; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D014792:Visual Acuity